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Meta-Analysis
. 2021 Jul;25(7):751-760.
doi: 10.1007/s10151-021-02436-5. Epub 2021 Apr 1.

Impact of a defunctioning ileostomy and time to stoma closure on bowel function after low anterior resection for rectal cancer: a systematic review and meta-analysis

I Vogel  1   2 , N Reeves  3 , P J Tanis  4 , W A Bemelman  4 , J Torkington  3 , R Hompes #  4 , J A Cornish #  3
Affiliations
Meta-Analysis

Impact of a defunctioning ileostomy and time to stoma closure on bowel function after low anterior resection for rectal cancer: a systematic review and meta-analysis

I Vogel et al. Tech Coloproctol. 2021 Jul.

Abstract

Background: Impaired bowel function after low anterior resection (LAR) for rectal cancer is a frequent problem with a major impact on quality of life. The aim of this study was to assess the impact of a defunctioning ileostomy, and time to ileostomy closure on bowel function after LAR for rectal cancer.

Methods: We performed a systematic review based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Comprehensive literature searches were conducted using PubMed, Embase and Cochrane databases for articles published from 1989 up to August 2019. Analysis was performed using Review Manager (version 5.3) using a random-effects model.

Results: The search yielded 11 studies (1400 patients) that reported on functional outcome after LAR with at least 1 year follow-up, except for one study. Five scales were used: the Low Anterior Resection Syndrome (LARS) score, the Wexner score, the Memorial Sloan Kettering Cancer Centre Bowel Function Instrument, the Fecal Incontinence Quality of Life scale, and the Hallbook questionnaire. Based on seven studies, major LARS occurred more often in the ileostomy group (OR 2.84, 95% CI, 1.70-4.75, p < 0.0001: I2 = 60%, X2 = 0.02). Based on six studies, a longer time to stoma closure increased the risk of major LARS with a mean difference in time to closure of 2.39 months (95% CI, 1.28-3.51, p < 0.0001: I2 = 21%, X2 = 0.28) in the major vs. no LARS group. Other scoring systems could not be pooled, but presence of an ileostomy predicted poorer bowel function except with the Hallbook questionnaire.

Conclusions: The risk of developing major LARS seems higher with a defunctioning ileostomy. A prolonged time to ileostomy closure seems to reinforce the negative effect on bowel function; therefore, early reversal should be an important part of the patient pathway.

Keywords: Bowel function; Ileostomy; Low anterior resection; Low anterior resection syndrome; Rectal cancer.

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Conflict of interest statement

No funding was received for conducting this study. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Prevalence of major LARS in ileostomy and no ileostomy group. Event is defined as major LARS. LARS low anterior resection syndrome
Fig. 3
Fig. 3
Time to stoma closure major LARS vs no LARS. LARS low anterior resection syndrome; SD standard deviation
See this image and copyright information in PMC

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